Serum total renin after tubal sterilization.

The effect of laparoscopic tubal sterilization by Hulka or Filshie clips on serum total renin levels was evaluated in 33 healthy, regularly menstruating women. Serum total renin levels were measured in the follicular (days 3 to 7) and in the luteal (days 20 to 24) phase during the cycle immediately preceeding the sterilization and 12 months after the procedure. The total renin secreted did not change after the sterilization. The follicular phase levels were lower (160 +/- 113 and 170 +/- 93 ng/l, respectively) than luteal phase levels (230 +/- 124 and 228 +/- 83 ng/l, respectively) in both cycles studied (p=0.0001 for both). The length of the menstrual cycle was not affected, either. Laparoscopic tubal sterilization caused no measurable changes in total renin secretion during one year follow-up.

Luteal function declines after laparoscopic sterilization by Hulka or Filshie clips.

We evaluated the influence of laparoscopic sterilization by Hulka or Fishie clips on corpus luteum function. Changes in corpus luteum function were evaluated in 46 women, before and after sterilization by Hulka (n = 22) or Filshie clips (n = 24). The mean age of the participants was 37 years (range 31-43 years). All women were healthy with regular menstrual cycles. Serum progesterone (P) was measured in one cycle before, and 3 and 12 months after the sterilization on cycle day 20-24. Endometrial biopsies were performed in the luteal phase before and one year after the procedure. The women measured the basal body temperature daily and kept a menstrual diary. The luteal phase P concentrations declined after the sterilization and the values were at the lowest level 3 months after the procedure (27.9 +/- 14.3 nmol/L vs. 18.7 +/- 13.4 nmol/L, = 0.0016). The values seemed to have recovered by 12 months (23.0 +/- 14.0 nmol/L, = 0.114 vs. baseline). Endometrium tended to be out-of-phase more frequently 1 year after the sterilization than before the surgery (= 0.065). Laparoscopic tubal sterilization is associated with an increased risk of luteal phase deficiency. However, the change may be only temporary in nature.

[Late effects of sterilization in women]. / Naisen sterilisaation myöhäisvaikutukset.

Sterilization affects measurably the circulation and the functioning of the ovaries, but further studies are required to estimate the clinical meaning of the change.

PIP: In Finland, every year a total of 11,000 female sterilizations are carried out, whereas worldwide 400 million such procedures are expected to be performed by the year 2000. In the past decade, major changes have occurred in the technical aspects of the procedure. Unilateral and bilateral endocoagulation of the Fallopian tube used to be standard procedure, but at the present time, when using the method of choice, laparoscopy, a clip ties the tube. Post-sterilization symptoms include pain (10-26% of cases), pain irrespective of menstrual cycle (6-40%), dyspareunia (4%), premenstrual tension (6-40%), and prolonged menstruation. Arterial blood flow between the uterus and Fallopian tube may be disturbed and tissue damage may result infrequently. Earlier methods of female sterilization produced more tissue damage, as clips affect blood circulation. In one study, lower abdominal circulation was measured by Doppler ultrasound and compared with nonsterilized subjects 2 days before sterilization, 2 days after, and 3 months later. The results indicated that patients whose uterine blood flow had decreased subsequently returned to the previous normal value, but in the ovaries the change was greater and return to the previous value did not occur. The author's own study used salivary samples 1 month before sterilization, 3 months after sterilization, and 1 year afterwards during a whole menstrual cycle. Total progesterone values slowly decreased 1 year after sterilization. Within the menstrual cycle, the peak of the progesterone level was the lowest 3 months after sterilization and it did not reach the pre-sterilization level. Sterilization exerts a measurable effect on the ovaries, but more investigations are needed to confirm this finding.

Salivary progesterone concentrations after tubal sterilization.

OBJECTIVE: To find out if ovarian endocrine function is hampered by laparoscopic tubal sterilization. METHODS: Salivary progesterone levels were measured in 55 women undergoing a laparoscopic tubal sterilization with Hulka or Filshie clips. The participants were 31-43 years old (mean 37) and were menstruating regularly. The saliva was collected every morning during three menstrual cycles: on the cycle preceding sterilization, and 3 and 12 months after the procedure. Salivary progesterone levels were determined by a radioimmunoassay. RESULTS: Total progesterone secreted in the luteal phase declined slowly after the sterilization, resulting in the lowest values 1 year after the procedure (1780 +/- 807 versus 2431 +/- 1187 pmol/L before surgery, P = .001). The luteal peak progesterone values were lowest 3 months after sterilization (277 +/- 137 pmol/L). Although the peak progesterone secretion seemed to have started to recover at 12 months (318 +/- 171 pmol/L), it was still significantly less than before surgery (378 +/- 150 pmol/L, P = .015). The length of the entire menstrual cycle and the lengths of the follicular and luteal phases were not affected. CONCLUSION: Although the menstrual pattern was not affected, laparoscopic tubal sterilization caused measureable changes in the luteal function. However, these changes may be temporary in nature.

Increased uterine and ovarian vascular resistance following Filshie clip sterilization: preliminary findings obtained with color Doppler ultrasonography.

The effect of Filshie clip sterilization on uterine and ovarian circulation was studied with color Doppler ultrasonography in 16 women before and twice after the operation. As a whole, the vascular resistance was slightly raised in the largest uterine artery and in the fundal parts of the uterine arteries; likewise in the ovarian arteries 2 days after sterilization. The resistance in the uterine arteries approached the presterilization level at 3 months after the operation, although these changes were not statistically significant. Two women had pelvic pain in the first days after the procedure, and they were compared with the symptom-free patients. Two days after sterilization, the patients with pain had significantly higher vascular resistance in all parts of the uterine arteries as compared to the symptom-free patients. After 3 months the difference had decreased in the largest uterine arteries and in the middle parts of the uterine arteries, but in the fundal parts the resistance was still higher than before sterilization. Vascular resistance in the ovarian arteries was increased in both groups, although the elevation was more pronounced in patients with pain. These preliminary findings imply that sterilization may cause an increase in the local vascular resistance, which is measurable by color Doppler sonography.

PIP: The effect of Filshie clip sterilization upon uterine and ovarian circulation was studied using color Doppler ultrasonography in 16 women before and twice after the operation. Preliminary findings suggest that sterilization may cause an increase in the local vascular resistance. Overall, vascular resistance was slightly raised in the largest uterine artery and in the fundal parts of the uterine arteries. Vascular resistance was also slightly raised in the ovarian arteries two days after sterilization. Resistance in the uterine arteries approached the presterilization level three months after the operation, although these changes were not statistically significant. Two women had pelvic pain in the first days following sterilization. Vascular resistance in the ovarian arteries was increased in both groups, although the elevation was more pronounced in patients with pain.